Co-ordination of care is key to driving down healthcare costs
|Issued by: Magna Carta|
[Johannesburg, 14 August 2014]
According to health risk manager, Medscheme, the establishment of clearly defined care pathways that centralise key information needed to make holistic clinical decisions is essential to containing burgeoning healthcare costs.
"By introducing principles that place the beneficiary at the centre not only supports the delivery of quality healthcare, but also cost-effective services to beneficiaries and their families," says Jane Ball, General Manager: Clinical Fund Management at Medscheme.
She recently spoke at the Annual Managed Healthcare Symposium, in Johannesburg. The symposium brought together industry leaders to share information around clinical and outcomes management as well policy and regulatory changes affecting the sector.
Medscheme defines co-ordination of care as "the deliberate organisation of patient care activities between two or more participants involved in a patient's care to facilitate delivery of healthcare services".
Currently, a combination of factors, including a fragmented healthcare system and the increasing burden of disease, are driving up healthcare costs across both the public and private sectors.
"Because delivery of care is distributed across a range of healthcare providers – from GPs to specialists to hospitals to auxiliary health services – the result is wastage and inefficiencies across the entire delivery chain as well as less than optimal outcomes," says Ball.
The co-ordination of care would establish a relevant mechanism for sharing information between healthcare service providers. In this way, a patient's principal care provider has a holistic view of all treatment the patient is receiving, and is able to communicate with other providers.
This greater co-ordination between service providers would also assist beneficiaries and their families to navigate the healthcare system.
"Part of the challenge when delivery of care is fragmented, is that adherence to care pathways is often not followed up on or monitored, and ultimately, the healthcare outcomes for the patient are sub-optimal," says Ball.
Data produced by Medscheme's Health Intelligence Unit indicate that greater co-ordination of care between service providers, ranging from general practitioners to specialists, could present significant cost savings for medical scheme members, based on their care utilisation patterns.
By co-ordinating patient care and introducing financial incentives or reimbursement structures that support co-ordination efforts, outcomes will also be more measurable.
"Not only with there be improved productivity and greater financial efficiency across the service provider network, the resultant improved quality of life for patients and beneficiaries is by far the most positive outcome," says Ball.